| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
12 |
$1K |
| V2020 |
Frames, purchases |
190 |
176 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
38 |
$417.44 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
120 |
116 |
$203.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
50 |
$197.42 |
| 92015 |
Determination of refractive state |
268 |
246 |
$0.00 |